Dear All,
I say dear all because without taking a history, examining a patient and organising special investigations I cannot offer individuals advice via the internet.
I was interested in all the advice offered so far without there really being a diagnosis. This is OK I guess if the pain is recent in onset (less than 6 weeks) and not life threatening. Treatment, if it is to be effective, for any condition depends on the diagnosis. Treatment should be evidence based especially if it is to be paid for. This holds true for the patient paying for NHS treatment through taxation or out of their own after tax income. Casual advice is not without cost especially if you include a patients time adhering to or trying out casual advice.
I am going to give you all some information on the patients who come and see me with pain above the patella (knee cap) in the region from 11am to 1pm (if you consider the patella as a clockface). Any of the structures beneath this area can cause pain. The structures below this region include: skin, vessels, nerves, fat, patella spurs (in the older patient), quadriceps tendon, synovium, the suprapatella plica, intra-articular bands, extraperiosteal fat, periosteum, the femur. Believe it or not, over the last 25 years, I have seen pathology causing pain in this region from all of these tissues. Some of these causes are benign and easy to fix by advice others not so.
So what should you do if you have pain in a knee that lasts more than 6 weeks?
A pain that is mechanical easy to pinpoint and is not relieved by conservative measures like exercise, manipulation, physiotherapy, pain killers, orthotics, magic crystals etc? The answer is go to your GP.
To go and see a GP first is sensible whatever you think of him or her. GP's often are well enough trained to take a history, examine you and triage you to the next step. If this is a pat on the head and a non-steriodal anti-inflammatory try it. If that does not work go back and ask for a referral. Pain in the knee lasting over 6 weeks is not normal. Crepitus (creaking knees climbing stairs) is not normal.
So who should I see?
The first person to see is a Consultant in Orthopaedics and Trauma.
You have the right to ask for a referral of a second opinion. This is where you will get the time to have a proper history, examination and special investigations (even in the NHS). The advice you get from a Consultant in Orthopaedics and Trauam does depend on three things:
- Who you have seen (in the NHS many patients do not get to see a Consultant).
- Whether the professional you have seen has properly correlated the history and examination findings with the special investigations (many scans are not fully or properly reported these days and sometimes the symptoms do not match the findings on MRI).
- The experience of the Consultant (you are going to do better with a Knee Surgeon for knee problems thatn a hip surgeron).
Do not expect an operation just because you are seeing a surgeon. I estimate that about 50% of the patients I see do not need surgery. This is largely because the patient I am referred have excellent GP's and Physiotherapists.
Hope this helps.
John Hardy
